An investigation into the determinants of sanitation success in Sub-Saharan Africa.

Abstract

The importance of sanitation in promoting good health and socio-economic development is widely acknowledged. Despite the numerous efforts made towards improving the sanitation situation, access to improved sanitation remains very low especially in Sub-Saharan Africa (SSA), which failed to meet its 62% Millenium Development Goal (MDG) sanitation target. by 32 percentage points. While the findings from previous studies provide critical information that could help address the underlying causes of poor sanitation performance in SSA, the focus was mainly on economic, environmental, social and political factors without recognising the influence of technological factors. The previous studies also resulted in inconclusive and contradictory results due to differences in methods and sanitation success indicators. This study investigated the factors that determine sanitation success in SSA and developed a sanitation success index for assessing sanitation performance. The study focus was SSA, an African region located south of the Sahara Desert. Three aspects characterised the research strategy adopted in this study: quantitative, qualitative and composite index construction. The study concluded on four main points. Firstly, the results on the impact of sanitation monitoring approaches (government and Joint Monitoring Programme (JMP) for Water Supply and Sanitation) on sanitation estimates for SSA countries showed that the government sanitation estimates were overestimated although no consistent bias of one approach versus the other was found. The overestimation of government sanitation estimates could not be attributed to the use of lenient definitions of ‘improved sanitation access’ only, an indicator used to differentiate between the government and JMP monitoring approaches. Secondly, through integrating multiple regression analysis, cluster analysis and key-informant interviews, this study demonstrated that sanitation success in SSA was associated with level of education, income level, population density, political stability, cultural beliefs and lack of technical capacity to develop innovative and affordable sanitation options. In addition, urbanisation, poverty, governance issues such as lack of proper sanitation regulatory controls, lack of implementation of policies and corruption were also demonstrated as influencing sanitation success. Thirdly, using two sanitation success indicators namely ‘proportion of the 2015 population that gained access to sanitation since 2000’ (GAINACC) and ‘access to improved sanitation as a percentage of the 2015 population’ (ACCSAN), the study demonstrated that sanitation success was influenced by access to flush toilets (flush/pour-flush toilets connected to septic tanks (FPST), flush/pour-flush toilets connected to piped sewer (FPPS), flush/pour-flush toilet connected to pit latrine (FPPL)) which in turn led to lower diarrhoeal mortality rates in countries which had high coverage of flush toilets. Fourthly, the application of Sanitation Success Index (SSI) developed to assess sanitation performance based on the primary functions of sanitation namely protecting human health and environmental protection showed its potential as a tool for assessing and comparing sanitation success across different countries at various levels of achievements in the selected indicators. It identified the relationship between a country’s sanitation success and GDP per capita, government effectiveness, political stability and level of education achieved by a country. Further research is required to refine the SSI as more high-quality data become available.